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The Role of Smallpox Vaccination in Mortality Decline in the Great Britain through Eradicating the Disease
be wee XVIII-XX ce uries – Fac s or a Poli ical Ari hme ick?” Mamurjo Rahimov U iversi y of Illi ois a Chicago Depar me of Eco omics “Whoever would u ders a d he poli ical phe ome o k ow as ‘ he A i-Vacci a io Agi a io ”- a d i s mag i ude would seem o i dica e i as bei g a leas wor h u ders a di g – mus remember some o e or wo fac s, fac s obvious e ough i deed, bu co s a ly forgo e . A d chief amo gs hem his, ha every oppo e of he prac ice, every skep ic, wi hou excep io , as o i s be efi s, has i he firs i s a ce approached he ques io i a spiri a leas of impar iali y, a d probably all his prejudices s ro gly i i s favor” Alfred Mil es I roduc io I Oc ober of 1979, he World Heal h Orga iza io (WHO), officially declared smallpox, also k ow as variola, eradica ed. he disease ha was k ow o ma ki d as early as 1122 BC i Chi a, ook millio s of lives hroughou he world (Bri a ica.com). We all k ow ha WHO is a bra ch of he U i ed a io s Orga iza io , a d is dedica ed o pro ec he heal h of he ma ki d. However, U also has ma y o her bra ches deali g wi h issues like busi ess, eco omy, cul ure, educa io , migra io , o ame a few, a d fur hermore, he eradica io of smallpox is believed o be a collabora ive achieveme of mos of hese bra ches, bo h o local a d o global level. If so, his eradica io mus have bee a ou ced joi ly wi h, if o all, he a leas few o her U bra ches such as World Ba k, U DP, a d U ICEF. I would be very u fair for medical me o appropria e his grea achieveme of ma ki d all o hemselves. Al hough medical me do o like o me io i oo much, hey all recog ize ha eradica io of smallpox was o o ly heir meri . Eco omic his ory has co ribu ed sig ifica ly o he formula io of various eco omic heories. Amo g he eco omis s who have fou d his ory o be a impor a source for heir ideas o e ca ci e Adam Smi h, homas Mal hus, Alfred Marshall, Joh May ard Key es, Mil o Friedma , Rober Solow, a d Gary Becker. For eco omis s i is very impor a o s udy popula io his ory i order o come up wi h policies ha decrease mor ali y a d morbidi y of he popula io . Fac ors like life expec a cy, i fa mor ali y are co sidered o be key i dica ors of progress i a y cou ry. Lo ger life expec a cy mea s more ma power o move he i dus ry, larger co sumer base for produc s a d services. My purpose here is o elabora e i heore ical a d s a is ical plausibili y of smallpox vacci a io eradica i g he disease based o papers wri e abou he smallpox disease, a d o seek whe her he vacci a io , if efficie a all, weighed subs a ially i he ligh of o her forces ha caused decli e i mor ali y. I is qui e s riki g o read from Memoirs of Jacques Casa ova, a co emporary, ha “More people perish a he ha ds of doc ors ha are cured by hem” i hose ce uries, a d i co ras he commo belief ha i hose ce uries medical me sudde ly came up wi h “o e-size-fi s-all” cure for o e of he mos dreadful diseases of all ime, which, wi h li le modifica io s, if a y, co i ued o be admi is ered worldwide up u il he seco d half of he XX ce ury. For several ce uries u il ow, propo e s of vacci a io hailed smallpox vacci a io o be a prove wo der weapo i he ha ds of ma ki d i eradica i g he disease i he world, al hough here have bee a umber of schools of hough ha , if o disprove, he dimi ish he role of smallpox vacci a io i figh i g he disease o a i sig ifica level, which is he cha ge i he virule ce of smallpox.
We mus remember from Europea his ory ha he period i which he mos dras ic decli e i Bri ish smallpox mor ali y ook place coi cides wi h he ime Bri ai experie ced i dus rial revolu io , a d hus improved s a dards of livi g mus have played crucial role i reduci g suscep ibili y of he popula io owards i fec ious diseases (Krause, 1958). A good example is a paper wri e by several researchers from he U iversi y of Liverpool a d Ma ches er ha used ime-series a alysis o s udy he dy amics of smallpox i Bri ai i 1550-1800, a d fou d a s riki g correla io be wee whea price fluc ua io s a d epidemics (Du ca , 1993; also see Hellei er, 1957). Eco omis s almos always ry o use models i order o come up wi h logical i erpre a io s of curre a d pas eve s. O e such paper (Mokyr, 1993) ha ries o explai decli e i mor ali y i he ligh of eco omic forces, used s a dard heory of u ili y maximiza io as a s ar i g poi : Uj = Uj (Xij X j, Lj) where L is composi e family life expec a cy variable, subjec o he usual budge co s rai ∑XiPi = Y. I fur her goes o a d ries o es ima e he rise i k owledge (i hygie e a d sa i a io , i par icular), rela ive prices, public goods (co verge ce owards bes prac ices), a d he like a d heir co seque i flue ce o decreased mor ali y. Eco omis s agree ha k owledge always has i direc ly i flue ced every si gle area of ma ’s life, however he paper a emp s o go beyo d i direc rela io ship owards au o omous causali y, a d si ce lio ’s share of mor ali y a d morbidi y is a ribu ed o smallpox a ha period i his ory, i does seem ha a ge eral rise i he level a d scope of k owledge had direc effec o mor ali y decli e hroughou Bri ai . Much has bee said a d wri e abou he prac ice of vacci a io i ge eral a d smallpox vacci a io i par icular. If you read a couple ar icles a d books o how lucky we were o ob ai he k owledge abou vacci a io , you may feel ha , if o vacci es, ma ki d would be wiped ou from he Ear h by he dreadful i fec ious diseases of all ki d. While I am wri i g his paper, hu dreds more ew vacci es are bei g developed i s a e-of- he-ar medical labora ories a d millio s of people, you g a d old, are bei g vacci a ed, despi e he growi g opposi io from pare s, scholars, a d doc ors agai s ma da ory mass vacci a io . I is i eres i g o o e ha vacci a io remai s o be he o ly medical prac ice ha has o be e forced by law ( VIC.ORG). A Remarkable Decli e i Mor ali y Mor ali y a d morbidi y of a popula io , al hough closely rela ed, are wo differe hi gs. I do o wa o elabora e ha i a umber of developed cou ries, i cludi g he U i ed S a es, morbidi y of he popula io has bee growi g, while mor ali y has bee ra her low ( VIC.ORG s a is ics). I his paper, I ried o focus o falli g of mor ali y ra es i Bri ai be wee 18 h a d 20 h ce uries, a d he causes of his remarkable decli e. Eco omic gai s from falli g mor ali y ca ever be precisely es ima ed, because huma life is such he mos precious hi g o e ca ever have. Be wee 1750 a d 1914 mor ali y ra es we dow subs a ially everywhere i Europe, of course o a he same pace a d he same ex e .
For i s a ce, life expec a cy i Bri ai we from 30’s i 1750 o 50’s i 1914, a d crude dea h ra e fell from abou 25 per housa d i 1750 o 14-15 per housa d i 1914. he immedia e cause of his drama ic shif is u dispu edly decli e i i fec ious diseases i Europe, bu deeper causes of his phe ome o have bee fueli g deba es amo g hree major overlappi g “schools” ha have emerged o explai he causes behi d he mor ali y decli e. “ u ri io is ” school s resses improveme i livi g s a dards a d food co sump io as a resul of eco omic grow h o be major causes, whereas “preve is ” school co e ds ha his decli e i mor ali y ca be a ribu ed primarily o public policy such as smallpox vacci a io campaig s o mass level a d clea i g of sewage sys ems. he hird school, “exoge is s”, claims ha he decli e i mor ali y ca be explai ed by reduced virule ce of major i fec ious diseases o microbial level a d posi ive cha ges i clima e (Mokyr, 1993). Firs i ocula io a d la er vacci a io is ci ed o be plausible expla a io for his decli e. I ocula io , i primi ive a d crude way, was prac iced mai ly i a few Orie al a d Africa cou ries. Due o he limi ed scale of i ocula io , i s efficacy was o k ow well. People of E gla d lear abou i i 1721 whe Lady Mary Wor ley Mo agu’s daugh er was i ocula ed i Lo do ( ucker, 1963). I ocula io mus be formally defi ed o avoid mixi g i wi h he more rece prac ice of vacci a io . Smallpox i ocula io is he i jec io of smallpox virus ake from ac ual smallpox wou d of a pa ie , whereas smallpox vacci a io is he i jec io of cowpox virus. he symp oms hese wo prac ices produce sligh ly differ, bu hey are bo h carried ou for he same purpose – developi g immu i y i people agai s he ac ual smallpox disease. Edward Je er was he fou der of smallpox vacci a io i Bri ai , a d i eres i gly, i was by his medical i duc io ha he believed ha exposi g a perso o cowpox would re der he perso immu e o smallpox (1798). obody could prove empirically ha his exac ly was he case, a d for i s a ce William Hewso was o able o verify hrough umerous experime s wha Je er supposedly achieved. Charles Creigh o , a lear ed a i-vacci a or, i his book Je er a d Vacci a io (1889), proved ha Je er o o ly failed o demo s ra e, experime ally or o herwise, ha cowpox a d smallpox were biologically rela ed, bu obody else, u il he da e Creigh o ’s ow book was published, had do e so (Gree wood, 1930). Besides, he popula io , which was subjec o various vacci a io laws a d ac s, s ubbor ly resis ed o vacci a io (Mil es, 1897). he Ci y of Leices er became a ce er of such resis a ce, a d despi e he gloomy prophecies of medical me abou huge oll o be paid due o a large u vacci a ed popula io , i was o e of he ci ies ha suffered leas from several epidemics of 19 h ce ury ( AVL, 1910). Legal Side of he S ory I 1840 Bri ish Parliame passed “A Ac o Ex e d he Prac ice of Vacci a io ”, by which smallpox i ocula io ha was used prior o smallpox vacci a io o preve his disease was made a pe al offe ce. Si ce he prac ice of smallpox i ocula io da es back o 1721, i ur s ou his life-des royi g prac ice las ed for a hu dred a d we y years! he firs compulsory vacci a io law was Lord Ly el o ’s Ac i 1853.
The Birth of the United Nations During World War II, the powers aligned against the Axis called themselves the “United Nations.” The concept that label conveyed held great promise; after all, had the League of Nations been a more effective body, World War Il might have been averted altogether. From August to October 1944, the United States, Great Britain, the U.S.S.R., and China met at a Washington, D.C., estate called Dumbarton Oaks to sketch out plans for a new world body. The wartime allies-plus France-would constitute a peacekeeping (“security”) council, while the other nations of the world, though represented, would play secondary roles. The Dumbarton Oaks Conference was remarkably successful, except in regard to two major issues: the principle of unanimity among the security council members (Should action require unanimous consent?) and the Soviet demand for separate membership for each of its 16 republics. Meeting at Yalta in the Crimea, February 4-11, 1945, the Big Three—Roosevelt, Stalin, and Churchill—resolved their differences
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